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Form PTR-2B
Mobile Home Owners
Verification of 2020 Mobile Home Park Site Fees
(Applicant completes Parts I and III. Mobile home park owner or manager completes Part II.
Use blue or black ink. See instructions for completion on back.)

Part I — To Be Completed by Applicant

Social Security # – – Spouse’s/CU Partner’s Social Security # – –

Name
Last Name, First Name, and Middle Initial (Follow with first name and initial of spouse/CU partner if filing jointly. Only enter spouse/CU partner’s last name if different.)

Address
Street City State ZIP Code

Mobile Home Park Site #

A. Did someone who was not your spouse/CU partner occupy your mobile home and share
site fees with you? If you (and your spouse/CU partner) were the sole occupant(s), check “No.” Yes No
B. Indicate the share (percentage) of the site fees that you (and your spouse/CU partner)
paid. If you (and your spouse/CU partner) were the sole occupant(s), enter 100%. %

Part II — To Be Completed by Mobile Home Park Owner or Manager

2020 Site Fees
(Do not include municipal service fees or other charges)
1. Total site fees due for Calendar Year 2020 under agreement with mobile home park ................ $

2. Total site fees paid by resident(s) for Calendar Year 2020 only .................................................. $
If line 2 is less than line 1, do not complete the certification. The applicant is not eligible for a reimbursement.

Under the penalties of perjury, I certify that I am the owner or manager of ,
where the above mobile home site is located. I further certify that the above-stated amounts of site fees due were paid
for Calendar Year 2020 and are true and accurate to the best of my knowledge.

(Name) (Date)

(Title) (Phone)

Part III — To Be Completed by Applicant (AFTER Part II has been completed by mobile home park owner or manager)
3. Total site fees paid by all residents living at this address.
(Enter amount from Part II, line 2) ........................................................................................................ $

4. Share (percentage) of site fees that you (and your spouse/CU partner) paid.
(Enter percentage from Part I, line B as a decimal. For example, if the share is 50%, enter 0.50.
If 100%, enter 1.00) .............................................................................................................................. 

5. Total site fees paid by you (and your spouse/CU partner) (line 3 line 4) .......................................... $

6. Total property taxes paid by you (and your spouse/CU partner)
(Line 5 0.18) Enter this amount on line 10, Form PTR-2 ............................................................$

(If you complete this form, be sure to enclose it with your Form PTR-2 application.)

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Form PTR-2B – Instructions

Part I – To Be Completed by Applicant
Social Security Number. If your marital/civil union status Mobile Home Park Site Number. Enter the mobile home
as of December 31, 2020, was single, you must enter your park site number of the principal residence for which you are
Social Security number in the space provided on Form claiming the reimbursement in the space provided.
PTR-2B. If your status as of December 31, 2020, was mar-
ried/CU couple, you must report both applicants’ numbers in A. Multiple Occupants. Check “Yes” only if you occupied
the order in which the names are listed on the application. your mobile home with someone who was not your
If you were married or in a civil union but living apart from spouse/CU partner and shared mobile home park site
your spouse/CU partner, and you did not have access to fees with them. For example, you lived in your mobile
or receive support from their income, you are considered home with your sister. If you (and your spouse/CU part-
“Single” for purposes of the Property Tax Reimbursement. ner) were the sole occupant(s), check “No.”
You should enter only your Social Security number on Enter the share (per-
B. Percentage of Site Fees Paid.
Form PTR-2B. centage) of the site fees that you (and your spouse/civil
Name and Address. Print or type your name (last name union partner) paid. For example, if you and your sister
first) and complete address of the property for which you are lived in your mobile home and you both paid one-half
claiming the reimbursement in the spaces provided. Also of the site fees, you must enter 50% as your share. If
include your spouse’s/CU partner’s name if filing jointly. you (and your spouse/CU partner) were the sole occu-
pant(s), enter 100%.

Part II – To Be Completed by Mobile Home Park Owner or Manager
Enter the appropriate amounts for Calendar Year 2020 Compare lines 1 and 2.
as follows:
• If line 2 is equal to line 1, complete the certification
Line 1. Enter the amount of site fees due under the mobile portion of Form PTR-2B.
home park agreement entered into with the resident(s).
• If line 2 is less than line 1, do not complete the
Line 2. Enter the total amount of mobile home park site fees certification portion of Form PTR-2B. The applicant is
paid by, or on behalf of, the resident(s). Enter only amounts not eligible for a Property Tax Reimbursement.
actually due and paid for the calendar year.
Certification. Complete the certification portion of
Form PTR-2B.

Part III – To Be Completed by Applicant
Line 3 – Total Site Fees Paid. Enter the total site fees paid Line 5 – Total Site Fees Paid by Applicant. Multiply the
for the calendar year by all residents who lived in the mobile amount on line 3 by the decimal on line 4.
home for which you are claiming a reimbursement. (Enter Line 6 – Total Property Taxes Paid by Applicant. Multiply
amount from Part II, line 2.) the amount of site fees on line 5 by 18% (0.18) and enter
Line 4 – Percentage of Site Fees Paid. Enter your share the result in the box at line 6.
(percentage) of site fees paid from Part I, line B for the
calendar year. Enter this number as a decimal. For example,
if you lived in your mobile home with your sister and you
both paid 50% of the site fees, enter 0.50 on line 4. If you
(and your spouse/CU partner) were the sole occu pant(s),
enter 1.00.

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